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1
Q

Pregnant lady with a UTI (12/40 weeks gestation), which is most appropriate?

Amoxicillin
Cefalexin
Clindamycin
Erythromycin
Flucloxacillin
Isoniazid
Rifampicin
A

Cefalexin is ok for UTI in pregnancy.

2
Q

Which one of the following has been associated with convulsions in cases of overdosage?

Morphine
Pethidine
Methadone
Fentanyl
Codeine
A

Pethidine

3
Q

Mrs T normally takes carbamazepine, which of the following should she urgently report?

Diarrhoea
Drowsiness
Hirsutism
Hyponatraemia
Nausea
Neonatal Haemorrhage
Neural tube defects
Unexplained bruising or bleeding
A

Carbamazepine:

Blood, liver, or skin disorders, fever, rash, mouth ulcers, bruising, bleeding.

4
Q

What for CCB overdose?

A

CCB

5
Q

Mr D, who is 52 years old, has been diagnosed with type 2 diabetes. His GP has noted that he has failed to respond to diet modification and increase in physical activity and wishes to commence him on oral antidiabetic medication. He is not overweight and does not have any relevant contraindications to this condition:

Acarbose
Pioglitazone
Gliclazide
Metformin
Insulin
A

Metformin which is usually used in patients who are overweight, but can
also be “considered” in patients who are not overweight if appropriate. In practice in this case –
Gliclazide would be first line.

Acarbose - sucrose + starch = flatulence, CI in abdominal surgery.

Pioglitazone: increase peripheral insulin use by reducing resistance, heart faliure CI due to fluid retention, associated with bladder cancer and hepatic disturbances.

Gliclazide, short-acting (6hour) sulfonyl, can cause hypos.

6
Q

Dose of paracetamol for immunisations?

A

2.5ml qds (2.5ml = 60mg)

7
Q

Can methotrexate cause a miscarriage?

A

May harm unborn baby but unlikely to cause a miscarriage.

8
Q

Which of these are/is ACh inhibitor(s):

Galantamine
Memantine
Rivastigmine
Donepezil

A

Memantine: NMDA antagonists with a neuroprotective effect.

Donepezil: ACh inhibitor

Galantamine: ACh inhibitor

Rivastigmine: Licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease.

9
Q

Which of the following should be added to existing treatment of amlodipine in a 56 year old African patient?

Atenolol
Bendroflumethiazide
Indapamide 
Ramipril 
Valsartan
A

Valsartan:

ARBs are preffered second line after a CCB in treating a 56-year old, African patient.

10
Q

An antihistamine and serotonin antagonist indicated in the prophylaxis of migraines

A

Pizotfen

11
Q

Which of the following does NOT need to be excluded before starting treatment for osteoporosis?

Hyperparathyroidism
Hyperthyroidism
Hypothryroidism
Osteomalacia

A

Hypo does not cause osteoporosis

12
Q

scurvy is a deficiency of

A

Vit C

13
Q

Buccastem M is only licensed for what?

A

Nause and vomiting in previously diagnosed migraine, in adults aged 18 and over.

14
Q

Which of the following is LEAST appropriate in renal failure?

Chlorphenamine
Fybogel
Omeprazole
Paracetamol
Senna
A

Bulk-forming laxatives such as fybogel are best avoided in patients with renal impairment as they require high volumes of fluid intake to work.

There is also the risk of dehydration with laxatives.

Senna tablets/liquid are more suitable in patients with renal impairment.

15
Q

Failure to treat which of these may lead to heart failure?

Asthma
COPD
Anaemia
Diabetes
Epilepsy
Hepatic disease
Hypercholesterolamia 
Renal disease
A

When anaemia becomes severe, the heart has to pump harder and faster to compensate for the decreased oxygen levels in the body.

16
Q

When should sodium valproate be used in absence seizures?

A

When there is a high risk of GTC seizures.

17
Q

Itching down below, female, lot of discharge which is frothy-smelling and is yellow-green in colour:

Bacterial vaginosis 
Trichomoniasis Vaginalis 
Candida albicans 
Cervical polyps 
Toxic shock syndrome
A

BV: thin, white fishy-smelling discharge.

Cadida albicans: white, cottage-cheese like

TV: frothy, yellow-green smelly

18
Q

Can pregnant women use gaviscon or peptac?

A

Yh: following the lifestyle and dietary advices, an alginate preparation is advisable.

19
Q

Has both opiod agonist and antagonist properties. Sublingually, it is an effective analgesic for 6-8 hours. Its effects are only partially reversed by naloxone hydrochloride.

A

Buprenoprhine

20
Q

Patient with three-month history of feeling chronically tired, has been feeling sick for last week and pale in colour. These test results suggest what?

Haemoglobin: 110g/L (130-170g/L)
MCV: 112fL (80-99fL)
MCH: 36pg (27-32pg)
Ferritin: 50ng/L (20-200ng/L)
Folate: 4ng/L (8-13ng/L)
B12: 97ng/L (200-800ng/L)
Haemoglobinopathy
Methaemoglobinaemia 
Pernicious anaemia
Sickle cell anaemia 
Thalassaemia
A

The results suggest pernicious anaemia which is characterised by low levels of vitamin B12.

Increased MCV + MCH: Megaloblastic anaemia due to low vitamin B12 and/or flic acid.

I think all the other options are shown with really low haemoglobin levels?

21
Q

Is loperamide ok in renal failure?

A

Yes

22
Q

Which of the following best describes a mandatory activity that must be completed by pharmacy contractors on an annual basis as part of clinical governance?

Clinical governance toolkit
Clinical audits
Unpublished patient survey
Reaccreditation of services
Registering of premises
A

Two clinical audits must be completed each year under clinical governance.

Survery results must be published.

Registering of pharmacy premises happens every year but does not form part of clinical governance.

23
Q

Carbamazepine and SSRs (and other antidepressants) can both cause what electrolyte imbalance?

A

Hyponatraemia.

24
Q

Piroxicam topical treatment should be reviewed after how long?

A

4 weeks

25
Q

Has been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions: Patients should be monitored for dyspnoea, persistent cough and chest pain.

Rizaptriptan
Amantadine
Ergotamine Tartate
Pramipexole
Cabergoline
Benserazide
A

Amantadine: glutamate antagonist drug.

Ergotamine Tartrate: migraine

Pramipexole: Dopamine receptor agonsit, also restlesslegs (ropinirole)

Benserazide: dopa-decarboxylase inhibitor, which reduces the peripheral conversion of levodopa to dopamine, thereby limiting side-effects such as nausea, vomiting and CVD effects.

Carbegoline: pulmonary, retroperitoneal and pericardial fibrotic reactions:

An ergot-derived dopamine-receptor agonist (bromocriptine, cabergoline or pergolide) should only be considered as an adjunct to levodopa if symptoms are not adequately controlled with a non-ergot-derived dopamine-receptor agonist.

26
Q

Gliclazide has a black dot interaction due to enhanced hypoglycaemic effect when taken with what drug?

A

Warfarin

27
Q

Which of the following does NOT cause hyponatraemia?

Glimepiride
Gliclazide
Glipizide

A

Gliclazide does not cause hyponatraemia.

Glimepiride and glipizide do.

28
Q

Allopurinol is associated with what syndrome?

A

Steven-Johnsons-Syndrome

29
Q

Noriday (norhisterone) is defined as being late when?

A

more than 3 hours late, all progestogen only are the same except for desogestrel which is 12 hours.

30
Q

Recently prepared means

A

within 4 weeks

31
Q

Lithium works by:

Modulation of inward and outward current of gutamate receptors

Modulation of monovalent and divalant anions in neurons

Inhibition of a transaminase responsible for degrading gamma-aminobutyric acid

Modulation of sodium channels on neuronal cells, thus reducing hyperexcitability.

Modulation of sodium channels on neuronal cells, thus reducing hyperexcitability

Stimulation of a synaptic vesicle protein which leads to inhibition of neurotransmitter

A

Lithium works by:
Modulating glutaminergic receptor currents

Modulating monovalent and divalent CATIONS in neuronal cells.

Inhibition of a transaminase responsible for degrading gamma-aminobutyric acid: VALPROIC ACID potentially.

32
Q

Analgesic with both an opiod effect and enhances the serotonergic and adrenergic pathways

A

Tramadol

33
Q

What is used to treat patent ductus arteriosus other tha surgery?

A

Prostaglandin inhibitors –> NSAIDs –> Indomethacin or ibuprofen

34
Q

Which of the following is the single most possible consequence of the following drug interaction:

Co-beneldopa for PD + prochlorperazine 5mg tds for nausea

Bleeding risk increased
Bradycardia
Bradykinesia 
Cardiac arrhythmias
Confusion
Postural hypotension
Reduced eGFR
Thrombosis
A

Bradykinesia

35
Q

Do pharmacists have read/write access to SCR?

A

Not write.

36
Q

AED and can be given once daily due to long-half life:

Topiramate
Carbamazepine
Phenobarbital
Levetirecatam

A

Phenobabr

37
Q

Patient started on this drug needs to take extra precautions and to protect their skin from sunlight:

Indapamide
Lithium carbonate
Pizotifen
Promazine
Ramipril
A

Promazine makes the skin more susceptible to the UV rays from the sun.

As such, a patient on Promazine therapy is more susceptible to burning/sun burn and must take precautions in sunlight.

38
Q

Should statins be discontinued if there is an increase in the blood-glucose concentration or HbA1c?

A

BNF 2.12 states that statins should not be discontinued if there is an increase in the blood-glucose concentration.

NICE guidance following an MI states to use a high propensity statin (such as atorvastatin) initially with a view to switching over to a more cost-effective alternative such as simvastatin after a set period of time.

39
Q

Insulin glargine:

Insulin glulisine:

A

Glarg: long
Glu: fast

40
Q

Phenoxymethylpenicillin, with or without food?

A

Take phenoxymethylpenicillin when stomach is empty, this means an hour before or two hours after food.

Also empty stomach:
Pen V
Flucloxacillin
Ampicillin (not amoxicillin tho)
Tera + oxytetra
Rifampcicin

Bisphosphonates

41
Q

Why would metformin need to be stopped in a patient undergoing examination using an iodine-containg contrast agent?

A

Due to the risk of renal failure.

42
Q

Mr C, who is 62 years old, has been seen by the GP as he is currently suffering from persistent breathlessness due to his COPD. His is already prescribed a salbutamol inhaler which is not controlling his symptoms. He has a FEV 1 60%. Which of the following is the ONE most appropriate treatment option?

SAMA
LAMA
LABA+ICS combo
LAMA + LABA + ICS
Domicilliary oxygen
A

At this stage the options are either LABA or LAMA alone, as LAMA alone is only option presented this is the correct choice.

43
Q

Chloramphenicol can cause gray baby syndrome if excessive doses are used in neonates with immature hepatic metabolism. How does this present?

A
Abdominal distension
Pallid cyanosis (grey)
Circulatory collapse
44
Q

Amiodarone, azola antifungals and macrolides have what effect on simvastatin?

A

increase its levels

45
Q

What are the long-term PPI use risks? (4)

A
  1. C.diff
  2. Fractures (osteoporosis)
  3. Hypomagnesia
  4. CAP
46
Q

Cetrizine is only licensed for use in what ages?

A

> 2 for liquid.

47
Q

Which of the following statements about live vaccines is the best advice?

Two live vaccines should not be given together.

Giving parenteral or intranasal vaccines is thought to affect the immune response to subsequently administered oral live vaccines

Live vaccine and inactivated vaccine may be given at any time in relation to each other

Paracetamol should not be given routinely prior to immunisation with live vaccines.

Live vaccines can routinely be given to immunocompromised patients

A

If more than one non-oral live vaccine (e.g., live attenuated influenza vaccine [LAIV],
varicella, mumps) needs to be administered, it is recommended that the vaccines be given
on the same day. However, if this is not possible, doses of the live vaccines should be separated by at least four weeks. The four-week interval reduces the interference of
immune response to the first vaccine by the second vaccine. This rule for separation does
not apply to the administration of oral live vaccines not given on the same day: typhoid and
rotavirus. These vaccines can be given less than four weeks apart. However, this scenario
isn’t likely to occur because the age groups for which these vaccines are recommended do
not overlap.
Live vaccine and inactivated vaccine may be given at any time in relation to each other
(should either be given at same time or else 4 weeks apart)
In addition, parenteral or intranasal administration of a live vaccine is not thought to affect
the immune response of a subsequently administered oral live vaccine.
A live vaccine and an inactivated vaccine can be administered without regard to the timing
of the other. Antipyretics/analgesics such as acetaminophen or ibuprofen should not
routinely be given prior to immunization.
They might reduce a patient’s immune response. However, if needed, these meds can be
used for treatment of fever and pain as needed following vaccination.

48
Q

A patient is prescribed sodium bicarbonate 4.8g orally daily for a chronic condition:

Iron overload
GP6D deficieny
Prevention of neural tube defects
Uraemic acidosis
Neutropenia
Pernicious anaemia
Iron deficieny anaemia
Sickle-cell disease
A

Prevention of neural tube defects - Folic acid 400microgram low risk, 5mg high risk.

Pernicious anaemia - hydroxocobalamin.

Iron deficieny anaemia- Cosmofer after test dose.

Filgrastim - neutropenia

Sodium bicarboante - uraemic acidosis.

49
Q

MOAi are cautioned for use in cardiovascular disease.

True or False?

A

True.

50
Q

Terbinafine is associated with what skin disorder?

A

Toxic epidermal necrosis/SJS

51
Q

Can aspirin be used for prevention of cardiovascular events in someone with COPD who has previously had a CV event?

A

Yes

52
Q

The following are symptoms of what?

Rash,
Blood in stools,
Itchy skin,
Jaundice

A
Hepatotoxicity:
Amiodatone
Alpha-methyldopa
Isoniazid
Methotrexate
Vitamin A
Nitrofurantoin
Minocycline
Paracetamol 
Amoxicillin
Niacin
Valproic acid
Phenytoin
53
Q

What topical NSAID is associated with more frequent serious skin reactions?

A

Piroxicam

54
Q

Patient on levothyroxine 50mcg for six months newly initiated onto citalopram for depression have these test results:

Free T4: 110g/L (130-170g/L)
Free T3: (80-99fL)
TSH: 36pg (27-32pg)

What should be done?

A

If TSH level is high and the free T4 is low, this suggests an under-active thyroid.

If TSH level is low and the free T4 is high, this suggests an over-active thyroid.

A low TSH with low free T4 may be the result of failure of the pituitary gland.

The results therefore indicate undertreatment (TSH level is high but the Free T4 is low) and so the dose needs to be increased.

No interaction of note between citalopram and levothyroxine.

Levothyroxine should not normally be stopped before surgery.

55
Q

Calcium polystyrene resin treats

A

Hyperkalaemia.

56
Q

Long-term use of which one of the following laxatives can lead to a weakened bowel?

Senna
Lactulose
Docusate
Ispaghula husk

A

Senna is a stimulant laxative that can cause weakening of the bowel if used for prolonged periods.

57
Q

Clinical outcomes include what?

A

Length of hospital stay.
Adverse drug reactions.
Hospital readmission
Death

58
Q

Infants have what pH gastric contents?

A

High pH

59
Q

Patient with AKI, LEAST appropriate advice RE pain relief is:

The patient should only be given oral paracetamol up to three times a day

The patient should be monitored for signs indicative of coma.

Codeine must be avoided due to an increased risk of serious adverse reactions

The patient may have increased sensitivity to central nervous system side effects

Dihydrocodeine is the drug of choice and may be used at normal dosing irrespective of renal function

A

The advice regarding dihydrocodeine is the least appropriate as it is not the opioid of choice and care must be taken in renally impaired patients who require opioids.

60
Q

Which heparins have a lower risk of heparin induced thrombocytopenia?

A

LMWH lower than ufh

61
Q

What impact does severe renal impairment have on the plasma serum concentrations of highly protein bound drugs?

A

Severe renal impairment: protein leaks out of the kidneys and leaves the body in the urine, as a result there are less circulating proteins in the serum for these highly protein bound drugs to bind to and thus their active levels increase

62
Q

15 yr old type 1 diabetic using insulin glargine once daily and novorapid prn. Has a script for Co-amoxiclav. Which of the following is most appropriate advice?

Do not make any adjustments to your regular blood glucose monitoring.

Increase your blood glucose monitoing as well as your insulin dosing.

As you are not eating, you will not require you regulr insulin doses.

Inject your insulin intravenously whilst ill as this will give a rapid response

Monitor yourself for hypoglycaemia and reduce your regular insulin dosing.

A

During periods of illness, diabetics are more likely to encounter diabetic acidosis therefore increased monitoring is required and insulin requirement may be increased.

63
Q

How is hand foot and mouth treated?

A

PLenty of fluids to avoid dehydration
Soft foods
Paracetamol or ibuprofen

64
Q

Perindopril should be taken with or without food?

A

Perindopril should be taken on an empty stomach, preferabbly 60mins before eating.

65
Q

Target INR for DVT prophylaxis

A

3.5

66
Q

A newborn baby at 8 weeks is given a vaccine via the oral route. Which ONE of the following vaccines did the child receive?

Bacillus Calmette-Guerin (BCG)
Diptheria, Tetanus, and Pertusis (DTaP)
Hep B vaccine
Human papillomavirus (HPV)
Rotavirus vaccine
A

The rotavirus protects against rotavirus infection, a common cause of childhod diarrhoea and sickness. It is given at 8 and 12 weeks of age.

Rotavirus liquid vaccines are given by mouth (orally) to young infants.

67
Q

A 49 year old man is brought into A & E with nausea, vomiting, muscle twitching and
tremor. He is very unsteady on his feet and seems unable to co-ordinate his
movements. He appears to be dehydrated and says that he has managed to keep
taking all of his medications even though he has not been eating and drinking

Ciclosporin
Digoxin
Gentamicin
Lithium 
Methotrexate
Phenytoin
Sodium valproate
Theophylline
A

Lithium toxicity - acute poisoning - nausea, vomiting, cramping and sometimes diarrhoea.

Progession of acute toxicity can involve neuromuscualr signs such as tremulousness, dystonia hyperreflexia, ataxia and cardiac dysrhythmias.

68
Q

Which of the following best describes the mechanism of action of amlodipine in reducing blood pressure?

It exerts a positive inotropic effect which decreases myocardial stress and reduces blood pressure.

It inhibits the movement of potassium ions into vascular and myocardial smooth muscle cells.

It reduces myocardial contractility thus reducing electrical contractility and blood pressure.

It exerts a negative inotropic effect by inhibiting calcium in myocardial tissue which leads to vasodilation.

It blocks myocardial beta-adrenoceptors having a potent vasodilator effect which reduces blood pressure.

A

CCBs work by exerting a negative inotropic effect as well as inhibiting calcium in myocardial tissue, which leads to vasodilation and reduced blood pressure.

69
Q

Indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress:

Lorazepam
Temazapem

A

Lorazepam

70
Q

Why should chlorphenamine be used with caution or not at all in patients with decreased liver function?

A

Increased risk of drowsiness as chlorphenamine hepatic metab, risk of coma

71
Q

Out of the following which is the least emetogenic treatment:

Cisplatin
Doxorubicin
Mitoxantione (anthracycline derivative)
Vincristine
Cyclophosphamide
A

Vincristine least emetogenic out of those

72
Q

p.c. means

A

After food

73
Q

Drug use at all is not recommended during what stage of pregnancy?

A

First trimester

74
Q

What is an alternative to flucloxacillin for cellulitis in pen-allergic?

A

Clarithromycin

75
Q

Which of the following conditions is associated with a rash which is not itchy?

Ringworm
Impetigo
Dermatitis herpetiformis
Nappy Rash
Lyme disease
A

Lyme disease is caused by a bacterial infection from tick bites. An early symptom of this condition is a characteristic “bulls eye” rash at the site of the bite.

Not itchy.

76
Q

Mrs Q goes to her doctor reporting that she has been feeling sick, lethargic and quite
confused. At night, she says that she has been seeing strange halos around the lights
at home.

Ciclosporin
Digoxin
Gentamicin
Lithium 
Methotrexate
Phenytoin
Sodium valproate
Theophylline
A
Digoxin:
Confusion
irregular pulse
Loss of appetite
Nausea
Vomiting
Diarrhea
Fast heartbeat
Vision changes (unusual): blind spots, blurred vision, changes in how colours look or seeing spots.
77
Q

What is the interaction between co-amoxiclav and simvastatin?

A

Clavulanic acid and simvastatin can increase the risk of hepatotoxicty.

78
Q

There are three domains of public heath:

Health improvement
Health protection
Health service delivery and quality

What do they cover?

A

Health improvement including people’s lifestyles as well as inequalities in health and the wider social influences of health.

Health protection including infectious diseases and environmental hazards and emergency preparedness

Health service delivery and quality (also known as healthcare public health)

79
Q

The price of certain drugs which may be available as a branded product or a generic product is calculatec based on the manufacturers’ price for branded products and the generic product price. If not generic product is available the pharmacist will be paid for the cost of the branded product if they endorse on the rx.

Which of the following best describes the category of payment for basic prices of drugs described above?

Category A
Category B
Category C
Category E
Category M
A

Category A: Drugs which are readily available.
The Secretary of State determines the prices for Category A drugs to be the weighted average of the prices listed by the following four manufacturers and suppliers; AAH, Alliance Healthcare (Distribution) Ltd, Teva UK and Actavis on or before the 8th of the month being reimbursed. In the weighted formula, AAH and Alliance Healthcare (Distribution) Ltd prices have a weighting of 2, the prices from the other suppliers have a weighting of one.

Category B: Drugs whose usage has declined over time.

Category C: Drugs which are not readily available as generic and price is determined by Secretary of State based on that listed by supplier.

Category E: ???

Category M: Drugs which are readly available and price determined on information supplied by manufacturers - not an average.

80
Q

Amiodarone has a black dot interaction with which (if any) of the following:

Grapefruit juice
Amitriptyline
Simvastatin

A

Amiodarone interacts with grapefruit juice but just avoid the juice.

Amiodarone interacts with amitriptyline in a black dot interaction as increased risk of ventricular arrhythmias.

Amiodarone and simvastatin (max 20mg) both increase each others plasma concentration and both can cause myopathy.

(NB: amiodarone and amitriptyline react with parenteral erythromycin only)

81
Q

Which of the following causes HYPOcalcaemia

Bendro
Furosemide

A

Bendro causes:
Hyper - glycaemia, natraemia, kalaemia, calcaemia.
Hypomagnesia

Loops cause hypocalcaemia

82
Q

What is the target INR for recurrent thromboembolism?

A

3.5

83
Q

Already taking clopidogrel, is pen-allergic, needing H.pylori eradication:

esomeprazole 20mg twice a day, clarithromycin 250mg twice a day,
metronidazole 400mg twice a day

lansoprazole 30mg twice a day, clarithromycin 250mg twice a day, metronidazole
400mg twice a day

omeprazole 20mg twice a day, clarithromycin 250mg twice a day, metronidazole
400mg twice a day

pantoprazole 40mg twice a day, amoxicillin 1 gram twice a day, clarithromycin
500mg twice a day

rabeprazole 20mg twice a day, amoxicillin 1 gram twice a day, clarithromycin
500mg twice a day

A

Esomeprazole and omeprazole both reduce the efficacy of clopidogrel.
Omeprazole, a moderate CYP2C19 inhibitor, has been shown to reduce the pharmacological
activity of Plavix if given concomitantly or if given 12 hours apart. Consider using another
acid-reducing agent with less CYP2C19 inhibitory activity. Patient is allergic to penicillin, so
can’t have amoxicillin

84
Q

Which of the folllowing is LEAST appropriate in renal failure?

Panadol 
Gaviscon Liquid
Gaviscon Tablets
Remegel Tablets 
Gaviscon Advance
A

Paracetamol (Hedex ®, Panadol ® ) is safe and suitable to treat headaches.

For occasional treatment of indigestion a product such as Gaviscon ® Liquid or tablets can be taken. Gaviscon ®Advance should not be used as it contains potassium which may be restricted in renal disease.
Remegel ® tablets which contain calcium carbonate can also be taken occasionally provided levels of calcium in the blood are not raised above normal.

85
Q

When can pertusis immunity be transferred to the child from a pregnanct mum?

A

If she is immunised between 28-32 weeks of pregnancy.

86
Q

Which of the following medicines may affect a patients regular warfarin?

Ethambutol
Isoniazid
Omeprazole
Pyrazinamide
Rifampicin
A

Rifampicin is a potent enzyme inducer and therefore will increase the metabolism of particular drugs.

In this case it is rifampacin with warfin.

87
Q

Unilateral pain within and above the eye in the temporal region which lasts for two hours and occurs three times a day is:

Chronic daily headache
Cluster headache 
Medication-overuse headache
Migraine
Tension-type headache
A

Cluster headache.

88
Q

Which of the following carries the lowest risk of cardiovascular side-effects when used in standard doses?

Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam
A

High-dose naproxen is associated with less vascular risk than other NSAIDs.

High-dose diclofenac and possibly ibuprogen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs.

89
Q

Which of the following is NOT correct?

Chloroquine is unsuitable for malaria prophylaxis in individuals with a history of epilepsy.

Travel to malarious areas should be avoided during pregnancy; if travel is unavoidable, then only use personal protection (such as mosquito nets), as proguanil is contraindicated in pregnancy

Prophylaxis is not absolute and therefore infection can occur with any of the drugs recommended.

Prophylaxis should be continued for 4 weeks after leaving with the exception of Malarone.®

Chloroquine has an increased risk of ventricular arrhythmias when used with amiodarone.

A

Proguanil can be given in the usual doses during pregnancy as benefit of prophylaxis in malaria outweighs risk.

90
Q

Which of the following is the most appropriate treatment for pernicious anaemia?

Cyanacobalamin
Epoetin alfa
Ferrous sulfate
Folic acid
Hydroxocobalamin
A

The drug of choice is hydroxocobalamin, as cyanocobalamin is poorly absorbed.

91
Q

Which one of the following medicines carries the lowest risk of gastro-intestinal side-effects when used in standard doses?

Diclofenac
Ibuprofen
Indomethacin
Naproxen
Piroxicam
A

Ibuprofen

92
Q

What does R.U.L.E stand for?

A

Resist
Understand
Listen
Empower

93
Q

Which of the following is least likely to occur in Reye’s syndrome?

Vomiting
Seizures
Muscle aches
Raised white cell count
Raised transaminases
A
Initial symptoms can include:
•persistent, effortless vomiting
•listlessness (a lack of interest or enthusiasm) and a loss of energy
•drowsiness
•rapid breathing
•seizures (fits)

As the condition progresses, the symptoms may become more severe and wide ranging, and
can include:
•personality changes, such as extreme irritability, agitation or aggressive behaviour
•delirium (a severe state of mental confusion and anxiety sometimes associated with
hallucinations)
•coma (loss of consciousness)
Blood tests: lft’s, wcc

94
Q

Are madopar dispersible equivalent to madopar capsules of same strength?

A

Yes

95
Q

What are the more water soluble beta blockers?

A
Least likely to cross BBB:
Atenolol
Celiprolol
Nadilol
Sotalol
96
Q

Phenytoin + fluconazole =

A

Toxicity
Visual disturbances, purple glove, slurred speech, confusion

elevated LFT

97
Q

Which of the following has the broadest spectrum of activity?

Amoxicillin
Ciprofloxacin
Clarithromycin
Co-amoxiclav
Doxycyline
A

Co-amoxiclav consists of amoxicillin and clav acid which is a beta-lactamase inhibitor.

98
Q

Can people with high Blood pressure use guaifenesin?

A

Yes

99
Q

Which of the following is associated with the greatest risk of gastro-intestinal side effects?

Aspirin
Naproxen
Diclofenac
Ketoprofen

A

out of those: Ketoprofen is associated with the greatest risk of gastro-intestinal side effects

100
Q

What painkiller should be used in those who cannot tolerate opioids?

A

Oxycodone

Initial dose of oxycodone IV is 2mg/hr

101
Q

How should cradle cap be managed?

A

Brushing, soaking etc.

102
Q

The use or oral prednisolone and ciprofloxacin increases the risk of what?

A

Tendon rupture

103
Q

Man taking darunavir 800mg, ritonavir 100mg and Truvada (emtricitabine and tenofovir) all 1 od, wants an OTC product for hay fever (runny nose). Which of the following is the most appropriate?

Fluticasone nasal spray
Beclometasone nasal spray 
Nasacort nasal spray
Otrivine nasal drops
Sterimar nasal spray
A

Fluticasone interacts with:
Ritonavir
Darunavir

Nasacort (triamcinolone) interacts with:
Ritonavir
Darunavir

Otrivine must interact then?

Beclometase interacts with none of the meds.

104
Q

Seretide is what?

A

LABA (Salmeterol) + Fluticasone (ICS)

105
Q

Freshly prepared means

A

within 24 hours

106
Q

Which of the following is recommended for patients visiting Mecca?

BCG vaccine
Hepatitis B vaccine 
Influenza vaccine
Meningococcal B vaccine
Meningococcal quadrivalent ACWY
Pneumococcal conjugate vaccine
Rotavirus 
Tetanus
A

Meningitis ACWY immunisation is recomended for patients visiting Mecca.

107
Q

Otomize ear spray is usually given as what dosing?

A

Three times daily

108
Q

Which of the following symptoms is most likely to be associated with acute sinusitis?

Dull, diffuse bilateral pain that often eases on bending down

Dull, diffuse bilateral pain that is often worse on bending down

Dull, localised unilateral pain that often eases on bending down

Dull, localised unilateral pain the is often worse on bending down

Sharp, localised bilateral pain that often eases on bending down

A

Dull, localised unilateral pain the is often worse on bending down

109
Q

Mr LK, 54 years old is suffering from congestion for the past 4 days, he tells you his nose is blocked. He currently takes a nasal spray recommended by his GP for hay fever.

He also stopped taking phenelzine one week ago.
He finally mentions he has tried steam inhalation.

What type of OTC product would be most unsuitable?

A

Pseudoephedrine would not be appropriate - there is a risk of hypotensive crisis when pseudoephedrine is given with MAOIs - avoid psuedoephedrine for at least two weeks after stopping MAOI.

110
Q

SL GTN typically provides relief for:

2-5mins
10-15mins
20-30mins
60-80mins

A

20-30mins

111
Q

Which one of the following is indicated in phenytoin toxicity?

Nystagmus is a late complication
Alopecia is a complication
Agranulocytosis
Vitamin D metabolism abnormalities can occur
Increase in deep tendon reflexes are a manifestation of phenytoin toxicity.

A

Vit D metab abnormalities in phenytoin.

Nystagmus happens early on.

112
Q

Which of these is most likely to have caused gout?

Allopurinol 
Atorvastatin 
Clopidogrel
Indapamide
Lisinopril
A

Indapamide

113
Q

What is the best monitoring parament for smoking cessation progress?

A

Carbon monoxide monitoring is useful in following up smoking cessation treatment compliance. It is worth noting that the lungs will contain some residual carbon monoxide from road pollution.

114
Q

Which of the following is most likely to have worsened a patients diabetic control?

Amlodipine
Atorvastatin 
Citalopram 
Olanzapine 
Zopiclone
A

Olanzapine

115
Q

Daptomycin is a lipopeptide antibacterial that only treats what type of infection?

A

Gram Positive, skin and skin structure infections, only via IV, works by disrupting cell membrane function.

116
Q

Why do black patients respond better to diuretics?

A

Increased salt sensitivity and therefore renal vascualr resistance.

117
Q

If amiodarone is found to be causing hyperthyroidism, what should happen?

A

It should be withdrawn, at least temporarily to help achieve control.

118
Q

Best antidepressant in a patient with unstable angina, or a recent heart attack is

A

Sertraline

119
Q

Which of the following cannot be prescribed in instalments?

Buprenorphine
Buprenorphine/naloxone
Chlordiazepoxide
Diazepam
Methadone
A

All Sch 2 plus diazepam can be prescribed by instalments.

120
Q

Which of the following is NOT eligible for the free flu vaccination?

The main carer for an elderly or vulnerable person whose welfare may be at risk if the carer falls ill.

Pregnant women, in the second or third trimester.

Those who are 65 and over.

Those living in a long-stay residential care home or other long-stay care facility

A diabetic man of any age

A

Pregnant women of ANY stage of pregnancy are eligible.

Certain medical conditions:
Chronic respiratory conditions
CHD
CKD
C liver D
Chronic neurological disease
Diabetes
Immunosuppression
Asplenia or splenic dysfunction
Morbid obesity
121
Q

The use of the SCR in the pharmacy setting is linked to what payment scheme?

A

The quality payment scheme in the community setting.

122
Q

A patient brings in a rx for isosorbide mononitrate 20mg tablets, one to be taken three times each day.

Which of the following is the most appropriate advice to give?

He will need to return to his GP as isosorbide mononitrate is given twice daily.

Development of tolerance is not associated with tablet formulations of isosorbide mononitrate

He needs to ensure he takes it regularly at 6 hourly intervals

He is unlikely to experience any headache or flushing with this drug.

He can chew on the tablets if a heart attack is suspected whilst somone calls an ambulance.

A

Needs to be taken so that there is at least an 8 hour nitrate free interval

123
Q

In stoma care, how should iron be supplemented?

A

Parenteral if oral not working, NOT MR forms.

124
Q

Which of the following can be used IV and acts by inhibiting sodium and potassium activated myocardial adenosine triphosphate?

Adenosine
Amiodarone
Amphotericin
Ciclosporin
Infliximab
Insulin
Phenytoin
Tacrolimus
A

Amiodarone works by inhibiting myocardial ATPase activity via sodium and potassium channel inactivation.

125
Q

Licensed as a twice daily dose for mild to moderate dementia associated with Parkinsons disease:

Galantamine
Memantine
Rivastigmine
Donepezil

A

Answer: Rivastigmine

Memantine: NMDA antagonists with a neuroprotective effect.

Donepezil: ACh inhibitor

Galantamine: ACh inhibitor

126
Q

When should someone seek advice if the symptoms of slapped cheek have not improved?

A

Within 7-10 days.

127
Q

Which LTRA can cause liver disorder?

A

Zarfirkulast

128
Q

A patient with chronic kidney disease (not on dialysis) who has developed a high phosphate level (1.8 mmol /L), would be prescribed:

Phytomenadione 
Pabrinex
Sevelamer
Colecalciferol 
Menadiol sodium phosphate
Calcium polystyrene
A

High phosphate: sevelamer.

Warfarin overdose: Phytomenadione.

Alcohol abuse -> Wernicke’s encephalopathy -> Pabrinex

Vit K deficieny in fat malabsorption syndromes like biliary obstruction: Menadiol sodium

Primary hyperparathyroidism when parathyroidectomy not possibe: Cincacalcet - impacted by smoking.

129
Q

Which of the following is the LEAST appropriate in renal failure?

Zantac (ranitidine)
Pepcid (famotidine)
Gaviscon Liquid
Tagamet (cimetidine)
Remegel tablets
A

Ranitidine (Zantac ®), famotidine (Pepcid ®, Boots Excess Acid Control ®) and nizatidine can also be purchased for short term relief of heartburn, particularly when the symptoms are related to consumption of food and drink. Cimetidine (Tagamet ®) is also available to buy but can lead to a rise in the blood test for Creatinine, which will make it seem as if kidney function has got worse – so best avoided if there is an alternative.

130
Q

What electrolyte imbalances can lead to digoxin toxicity?

A

Hypokalaemia and hypomagnesaemia.

131
Q

Is the AED which carries with it an increased risk of cleft palate if taken in the first trimester

A

Topiramte.

Also something to do with glaucoma risk.

132
Q

Trastuzumab (herceptin) has what side effects?

A
  1. Asthenia: abnormal physical weakness, lack of energy

2. Peripheral neuropathy

133
Q

Which of the following is not a risk factor for GORD?

Smoking
Verapamil 
Stress
Travelling abroad
Obesity
A
Risk factors for triggering GORD are:
Drugs which lower oesophageal sphincter relaxation (e.g. calcium channel blockers).
Smoking
Alcohol 
Obesity 
Stress
134
Q

A dopamine receptor antagonist which acts centrally by blocking the chemoreceptor trigger zone:

Promethazine
Prochlorperazine

A

Prochloperazine.

135
Q

Which of the following regarding indapamide is correct?

A common side-effect is hypernatraemia
It can be taken by breast feeding mothers
It is taken in the morning.
The usual dose is 5mg daily
There is no risk of cardiac toxicity if taken together with digoxin

A

A common side-effect of indapamide is HYPOnatraemia not HYPER.

It should not be used by breast feeding mothers.

It is taken first thing in the morning.

The usual dose is 2.5mg daily .

There is a risk of cardiac toxicity if taken with digoxin due to hypokalaemia.

136
Q

Which of the following is most appropriate for endoscopy pre-med in extremely anxious person?

Temazepam 10mg orally night before
Diazepam 10mg orally 2 hours pre-op
Midazolam 2.5mg SC, 5-10 mins pre-op
Lorazepam 3mg oral the night before the procedure

A

Midazolam is best option as need a short-acting agent with rapid onset of action

137
Q

The patient has been prescribed penicillin V for tonsillitis. She asks whether she will be okay to continue breastfeeding her 5 month old baby. What is the best advice for the patient?

She should avoid feeding the baby for 45 minutes after taking the medicine when it is at peak concentration

She should stop breastfeeding until after the course is complete

Pen V is considered compatible for breastfeeding but the infant should be monitored.

The patient should be referred to her health visitor

The treatment is not compatible with breastfeeding and the patient should be referred back to her GP

A

Pen V is considered safe but baby should be monitored.

Ceph too.

138
Q

Using an enema to deliver a medicine gives acces to the haemorrhoidal veins, what is the benefit of this?

A

Bypass first pass metabolism

139
Q

If a patient is taking phenytoin for epilepsy and develops blood or skin disorders, how should this be managed?

A

Withdraw the phenytoin.

140
Q

Which of the following is considered an active failure leading to a medication administration error?

Clinical negligence
Communication
Errors in execution 
Safety culture
Team structure
A

Errors in execution such as slips and lapses are considered active failures in the medication error model.

All other options are latent failures.

141
Q

All suspected adverse reactions in children should be reported to the MHRA even if the black triangle status has been removed.

True or False?

A

False.

In September 2014 the advice on which suspected adverse drug reactions (ADRs) to report in children was changed to be the same as adults. Originally, the MHRA requested yellow card reporting of all suspected ADRs in children but this is no longer necessary.

142
Q

Which of the following is LEAST appropriate for use in renal failure?

Zantac (ranitidine)
Pepcid (famotidine)
Oral Rehydration Sachets
Loperamide

A

Diarrhoea can result in fluid loss and upset fluid balance. Oral rehydration powder is sold for use in diarrhoea but since it contains both sodium and potassium it should be avoided in people with severe kidney disease except with medical advice. If the symptoms are mild, loperamide (Imodium ®) can be used to control them.

143
Q

Black patients have what level of circulating renin?

A

High

144
Q

Liver failure can be caused by:

Metformin
Acarbose
Insulin
Pioglitazone

A

The thiazolidinediones, like pioglitazone, have occasionally been associated with liver failure

(Acarbose not after abdominal surgery)

145
Q

OTC tamsulosin should not be supplied and referral should be considered for symptoms of BPH of less than what length of time?

A

Symptoms <3 months.

Referral if any leaking of urine (incontinence) in the last 3 months as this may indicate chronic urinary retention.

146
Q

Which of the following describes the morbidity rate?

The number of deaths per thousand population per year, scaled to population size.

Refers to the incidence rate of disease within a population.

The presence of two concomitant disease states, or conditions, in a patient at the same time.

The ratio of the risk of disease, or death, among people who are exposed to the risk factor, to the risk among people who are unexposed.

The number of deaths per hundred thousand people per year, scaled to population size.

A

Morbidity: incidence rate of disease within a person, so morbidity rate: incidence rate of disease within a population.

147
Q

Which of the following is it most appropriate to counsel to be taken with or just after food?

Amiodarone
Metronidazole
Co-beneldopa

A

Metro and co-beneldopa

NB: neither co-beneldopa or co-careldopa have warning labels regarding drowsiness….

148
Q

Simvastatin max dose of 20mg when with: (4)

A

Diltiazem
Amiodarone
Verapamil
Amlodipine

149
Q

The usual flixonase dosing for nasal polyps is

A

6 drops in each nostril daily.

Flixonase nasaluse contain 12 drops per pouch.

150
Q

What is procyclidine used for?

A

The EPS of parkinsons and antipsychotics

151
Q

What type of vaccine is the varicella-zoster vaccine?

A

Live

152
Q

Ramiprial can cause which of the following?

Bradycardia
Tachycardia

A

Tachycardia can be caused by ramipril.

153
Q

Which of the following is NOT a clinically significant interaction?

Amiodarone + Grapefruit juice
Codeine phosphate + Grapefruit juice
Colchicine + grapefruit juice
Fexofenadine + grapefruit juice 
Pravastatin + grapefuit juice
A

Rosuvastatin, fluvastatin and pravastatin can be safely taken with grapefruit juice.

154
Q

Hair falling out can be caused by what anticoagulant?

A

Warfarin

155
Q

Written consent is needed for the SCR, true or false?

A

There is a written form but consent can be verbal.

156
Q

Low sodium has what effect on lithium?

A

Toxicity

157
Q

Which of the following are stimulant laxatives?

Senna
Lactulose
Docusate
Arachic oil
Glycerol
A

Senna is a stimulant laxative which stimulates contractions of the gut.

Docusate sodium stimulates the gut and softens the stool.

Lactulose draws fluid from the blood and the fluid it is drunk with.

Arachis oil softens impacted stools

Glycerol causes peristalsis by irritating the area

Bulk-forming laxatives cause stimulation by increaseing faecal mass

158
Q

Which of the following is incorrect refarding midwife supply orders?

It must contain the occupation of the midwife
It must contain the patient for which the controlled drug is being obtained
It must contain the total quantity of drug to be obtained
It must contain the signature of an appropriate medical officer
It must contain both the name and address of the midwife

A

It is not a pre-requisite for a midwife to state their address on a midwife supply order.

159
Q

Mrs G, who is 55 years old, had been diagnosed with type 2 diabetes 6 months ago. She was prescribed metformin but suffered with chronic diarrhoea as a result of her treatment. Her GP decided to change Mrs G to dapagliflozin 10mg daily as monotherapy. What is the drug action of dapaglifozin?

Binds to, and activates the glucagon-like peptide-1 receptor to increase insulin secretion.

Inhibits dipeptidylpeptidase-4 to increase secretion and lower glucagon secretion

Decreases gluconeogenesis and increases peripheral utilisation of glucose

An inhibitor of intestinal alpha glucosidases and delays the absorption of starch and sucrose

Reversibly inhibits sodium-glucose co-transporter 2 in the renal proximal convoluted
tubule to reduce glucose reabsorption and increase urinary glucose excretion

A

GLP-1: Binds to, and activates the glucagon-like peptide-1 receptor to increase insulin secretion.

Gliptins: Inhibits dipeptidylpeptidase-4 to increase secretion and lower glucagon secretion

Metformin: Decreases gluconeogenesis and increases peripheral utilisation of glucose

Acarbose: An inhibitor of intestinal alpha glucosidases and delays the absorption of starch and sucrose

Glifozins: Reversibly inhibits sodium-glucose co-transporter 2 in the renal proximal convoluted
tubule to reduce glucose reabsorption and increase urinary glucose excretion

160
Q

What is the best treatment option for theophylline overdose?

A

Activated charcoal

161
Q

Children with stoma are at particular risk of what electrolyte imbalance?

A

Hypokalaemia

162
Q

Can Pharmacy technicians access a patients SCR?

A

Yes

163
Q

When should the following be stopped prior to surgery?

Warfarin 
Aspirin
Clopidogrel
Dabigatran 
Apixaban/rivaroxaban/edoxaban
A
Warfarin: one week. 
Aspirin: one week.
Clopidogrel: one week (irreversible platelet binding, platelets lives ~7days)
Dabigatran:
Major and ok renal: 48h
Minor and ok renal: 24h

Apixaban/rivaroxaban/edoxaban:
Major and any renal: 48h
Minor and ok renal: 24h

164
Q

Which of the following may cause hyperuricaemia?

Allopurinol
Febuxostat
Colchicine
Indapamide
Sulfinpyrazone
A

Indapamide can cause hyperuricaemia

165
Q

Indicated for conscious sedation for dental procedures 30-60 minutes before procedure:

Lorazepam
Temazepam

A

Temazepam

166
Q

What disturbances of calcium metabolism need to be corrected before starting zoledronic acid treatment?

A

Vitamin D deficiency

Hypocalcaemia

167
Q

Which one of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?

Candersartan
Levothyroxine
Dabigatran
Gliclazide
Dalteparin
A

NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura mater); no evidence of risk with LMWH.

168
Q

Which of the following is not a side effect of procyclidine?

Blurred vision
Constipation
Bradycardia
Dry mouth
Urinary retention
A

Procyclidine is an anticholinergic which can cause tachycardia not bradycardia

169
Q

What is the correct order of the following with regards to audit cycle?

Select criteria to review 
Make improvements
Prepare for audit
Measure performance
Sustain improvements
A
  1. Prepare for audit
  2. Select criteria to review
  3. Measure performance level
  4. Make improvements
  5. Sustain improvements
170
Q

How should the normal H.pylori treatment be modified in a patient who is penicillin allergic, takes ciclosporin and clopidogrel?

A

Omeprazole and esomeprazole = NO with clopidogrel.

Lansoprazole ok!

Penicillin allergic so NO amoxicillin: left with clarithromycin or metronidazole.

Ciclosporin and Clarithyromycin: NO! so has to be metronidazole.

Would probably need to add in tetracycline plus tripotassium whatever it is.

171
Q

Which of the following is the most likely cause of acute COPD exacerbation?

Chlamydia psittaci
E. coli
Legionella pnuemophillia
Moraxella Catarrhalis 
Pseudomonas aeruginosa
A

Common bacterial pathogens of acute exacerbations include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis.

172
Q

Which of the following medications would be suitable for a 24 year old male with an acute psychotic episode?

Paloperidone decanoate 50mg monthly
Olanzapine 10mg daily 
Haloperidol 10mg qds 
Clozapine 100mg tds
Flupenthixol decanoate 200mg every two weeks
A

Olanzapine: 2nd gen

173
Q

Can a child taking carbamazepine for epilepsy be treated with Ovex?

A

Yes, Ovex (mebendazole) is fine, it only interacts with cimetidine, increased mebendazole.

174
Q

Failure to respond to betamethasone valerate 0.025% cream. Which is the best next treatment to try?

Clobetasone butyrate 0.05% cream
Hydrocortisone acetate 1% cream
Clobetasol propionate 0.05% cream
Hydrocortisone butyrate 0.1% cream
Aclometasone dipropionate 0.05% cream
A

Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.

Moderate potency:
Alclometasone 0.05% 
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%

Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%

So failure to respond to a moderate potency cream, so wouldnt use a low potency hydrocortisone acetate 0.1% or another moderate potency cream so wouldnt use clobetasone butyrate 0.05% or aclometasone dipropionate 0.05% .

So the option would be hydrocortisone butyrate as a potent steroid because clobetasol propionate 0.1% is a VERY potent steroid so wouldnt go to that without trying a potent one first.

175
Q

Which is stronger:

Clobetasol butyrate vs Clobetasol propionate

A

Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.

Moderate potency:
Alclometasone 0.05% 
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%

Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%

176
Q

Which is stronger?

Betamethasone valerate 0.025%
Betamethasone valerate 0.1%
Betamethasone dipropionate 0.05%

A

Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.

Moderate potency:
Alclometasone 0.05% 
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%

Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%

177
Q

Which is stronger, Clobetasol vs clobetasone?

A

Clobetasone butyrate 0.05% = moderate.

Clobetasol propionate = very potent

Mild potency:
Hydrocortisone 0.1%, 0.5%, 1.0%, 2,5%.

Moderate potency:
Alclometasone 0.05% 
Betamathosone valerate 0.025%
Clobetasone butyrate 0.05%
Fluocinolone acetonide 0.001%
Potent potency:
Betamethasone dipropionate 0.05%
Betamethasone valerate 0.1%
Hydrocortisone butyrate 0.1%
Mometasone furoate 0.1%

Very potent:
Clobetasol propionate 0.1%
Diflucortolone valrate 0.3%

178
Q

How long does it take for myelosuppresion to occur?

A

If you’re in chemotherapy, your blood cell counts will begin to decrease between 7 to 10 days after starting treatment. In mild cases of myelosuppression, treatment is not necessary. Blood count production will return to normal in a matter of weeks.

179
Q

How to calculate IBW?

A

Men: 50kg + (2.3kg * [height in In - 60])

Women: 45.5kg + (2.3 * [helgiht in In - 60])

180
Q

IS the interaction between doxycycline and phenytoin clinically relevant?

A

No

181
Q

Patient on lymecycline, an acne cream and dermol is added, what is wrong with this?

A

Dont think dermol is indicated?

182
Q

Drugs for respiratory depression in elderly care

A

Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. Diazepam may be helpful for dyspnoea associated with anxiety. A corticosteroid, such as dexamethasone, may also be helpful if there is bronchospasm or partial obstruction.

183
Q

Why is glucose suitable as a diluent in IV therapy?

A

DONT KNOW

184
Q

What is the Green book used for?

A

Immunisations, vaccines.

185
Q

What is the Orange Guide for?

A

Manfucaturing

186
Q

Apixaban dose for stroke prevention in AF

A

5mg BD or reduced to 2.5mg BD if over 80, <60kg or Creatine >133

187
Q

What does CHA2DSVASc stand for?

A
Coronary Heart Disease
Hypertension
Age >65 = 1
Diabetes 
Stroke or TIA =2
Vascular disease
Age >75 = 2
Sex category, women = 1 point
188
Q

Apixaban dose for VTE prophylaxis following knee surgery

A

2.5mg BD 10-14 days

189
Q

What are the cardioselective beta blockers (NAMB)

A

Atenolol
Bisoprolol
Metoprolol
Nebivolol

190
Q

What does HASBLED stand for?

A
Hypertension
Abnormal liver or renal
Stroke
Bleeding already lol or predisposed
Labile INR (up then down then up then down etc)
Elderly
Drugs alcohol etc
191
Q

Which beta blockers are worse in breastfeeding?

A

Water soluble beta blockers are present in breast milk in greater amounts that other BB

192
Q

Apixaban dose for the treatment of DVT/PE

A

10mg BD 7 days then 5mg BD

193
Q

When should SSRI’s be taken?
What about TCA’s?
What about Mirtazepine?

A

SSRI’s- take in the morning as they are mildly stimulating
TCA’s- take at night as can cause drowsiness
Mirtazepine (tetracyclic)- take at night as can cause drowsiness

194
Q

Which of the following medications is most likely to cause hypernatremia?

Beclometasone inhaler
Bisoprolol
Felodipine
Prednisolone
Salbutamol inhaler
A

Corticosteroids may cause:
Sodium retention, potassium, calcium loss, most pronoucned with oral steroids. so prednisolone.

Salbutamol could cause hypokalemia

195
Q

Isosorbide mononitrate, 10mg twice a day counselling:

Headache occurrence tends to decrease with continued therapy

Tablets should be discarded 8 weeks after opening the packet

Tablets should be stored in a glass container

Doses should be spread evenly throughtout the day

Tablets may be dissolved under the tongue for faster relief of chest pain

A

Headache occurence will decrease, other stuff is for GTN tablets i think.

196
Q

Which of the following statements is false?

phytomenadione is a lipid-soluble analogue of vitamin k

phytomenadione prevents the hepatic synthesis of active prothrombin

phytomenadione is indicated in babies at birth in order to prevent vitamin
k deficiency bleeding

vitamin k deficiency bleeding may manifest in intracranial bleeding

vitamin k deficiency may occur in neonates due to medications taken by
the mother during pregnancy, for example: carbamazepine

A

Phytomenadione Promotes the hepatic synthesis of active prothrombin, so encourages clotting preventing haemorrhage

197
Q

Pain in the eye, red and watery, photophobia, difficulty reading small print, no trauma:

bacterial conjunctivitis

Iritis

Allergic conjuctivits

Sub-conjunctival haemorrage

viral conjunctivitis

A

Iritis

198
Q

Can you use fentanyl with moclobemide?

A

not advicsed best avoid

199
Q

Why is less phenytoin (on a mg/kg basis) needed to treat seizures in neonates compared to babies older than 3 months old?

the plasma concentration of phenytoin is higher in neonates than in
children

bilirubin is displacing phenytoin from albumin more readily in neonates

neonates have lower albumin levels leading to increased “free” phenytoin

phenytoin in equivalent doses is less toxic in neonates than in children

phenytoin is being excreted more slowly in neonates

A

Neonates have decreased plasma concentrations of albumin and alpha1-acid glycoprotein, resulting in increased plasma concentrations of unbound (active) drug.

Decks in Pharmacy Pre-Registration 20/21 Class (82):